RANULA
Definition: Ranula is a cystic swelling in the floor of the mouth.
The term Ranula is derived from the Latin word Rana meaning frog belly. The cyst looks like belly of a frog.
Theories:
- These are retention cysts in relation to mucous secreting glands of the sublingual mucous membrane. (Glands of Blandin and Nuhn).
- Retention cysts in relation to sublingual salivary glands.
- The plunging variety may be due to a forward prolongation of an un-obliterated part of cervical sinus.
Types:
A. Simple.
B. Plunging: (complex, deep).
A. Simple: Ranula is relatively localized and is a superficial dilated segment of a blocked or damaged sublingual gland duct.
B. Plunging (complex): Results from extension of oral variety or from the escape of mucus from a posterior sublingual gland which burrows along the posterior margin of mylohyoid down into submandibular region to form a cervical swelling.
Clinical features:
- Found in childhood.
- Situated on one side of frenum linguae either on the floor mouth, or under surface of tongue. A big cyst may encroach the other side of the floor of mouth deep to frenum linguae.
- Mucous membrane is freely mobile on the cyst.
- Cyst is bluish in color.
- Brilliantly transilluminant. Presence of white strands amidst reddish glow indicating presence of deep lingual veins along the wall, cyst or Wharton’s duct.
Pathology:
a) The wall is lined by epithelium (cuboidal, columnar, and ciliated) or by fibrous tissue.
b) Fluid is jelly like and colorless.
Treatment:
- Total excision: This is ideal but difficult as the cyst almost always ruptures during dissection due to its very thin wall.
- Partial excision with Marsupialization: This technique prevents recurrence.
- Plunging Ranula has to be approached from neck. The cyst is dissection between mylohyoids. Here, total excision along with removal of sublingual gland done.
Complications:
- Repeated trauma.
- Bursting of the cyst.
- Infections.
- Problems in speech and mastication.
- Damage to the Wharton’s duct.
Differential Diagnosis:
- Sublingual dermoid.
- Hemangioma.
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